Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 3457015 | WI |
Y | 213EG0000X | General Practice | 3457015 | WI |
NPI | 1003012709 |
---|---|
Provider Name | Mr. Stephen William Thomas |
First Address | Menomonee Falls, WI 53051 |
Second Address | Menomonee Falls, WI 53051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 08/07/2007 |